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lymphopenia
Defined as a total lymphocyte count of < 1000/uL.
Most patients with lymphopenia have a reduction in T-cells, & CD4+ T-cells (helper cells) in particular.
Etiology:
1) inherited causes
a) congenital immunodeficiency disorders
- severe-combined immunodeficiency disease
- aplasia of lymphopoietic stem cells
- adenosine deaminase deficiency
- absence of histocompatibility antigens
- absence of CD4+ helper cells
- thymic alymphoplasia with aleukocytosis (reticular dysgenesis)
- ataxia telangiectasia
- Wiskott-Aldrich syndrome
- immunodeficiency with short-limbed dwarfism (cartilage hair hypoplasia)
- immunodeficiency with thymoma
- cellular immunodeficiency with immunoglobulins
- purine nucleoside phosphorylase deficiency
- immune deficiency with venooclusive disease of the liver
b) idiopathic
- CD4+ T-lymphocytopenia
2) acquired causes
a) aplastic anemia
b) infectious diseases
- viral
- acquired immunodeficiency syndrome (AIDS)
- hepatitis
- influenza
- others
- bacterial
- tuberculosis
- typhoid fever
- bacterial pneumonia
- sepsis
c) iatrogenic
- immunosuppressive agents
- anti-lymphocyte globulin therapy
- glucocorticoids
- high-dose PUVA treatment
- cancer chemotherapy
- platelet apheresis
- radiation
- surgery
- thoracic duct drainage
d) in association with systemic diseases
- autoimmune disease
- rheumatoid arthritis
- systemic lupus erythematosus
- myasthenia gravis
- Hodgkin's disease
- protein-losing enteropathy
- renal failure
- sarcoidosis
- thermal injury
e) nutritional
- ethanol abuse
- zinc deficiency
3) older adults have lower lymphocyte counts than younger patients
Management:
- lymphopenia without clinical consequences of associated disease does not require treatment [2]
Related
lymphocyte
lymphocytosis
General
leukopenia
lymphocyte disorder
References
- Williams Hematology, 5th ed, Beutler et al (eds), McGraw Hill,
NY, 1995, pg 965-66
- Medical Knowledge Self Assessment Program (MKSAP) 19
American College of Physicians, Philadelphia 2022